OBJECTIVES: It would appear that ongoing economic austerity would lend itself to cost containment in healthcare through a natural increase in use of pharmaco-economic strategies in general, and risk-sharing agreements in particular. However, many governments are forsaking such tactics to focus on shorter-term quick fixes. Whilst recognising that risks-sharing agreements represent an important market access strategy, the objective of this research was to examine if the marked expansion in number of risk-sharing agreements through 2007-2010 is still continuing, or if there is a gradual levelling off across the world. METHODS: Secondary research was conducted examining reimbursement decisions around the world, with a special focus on Australia, Belgium, Brazil, Canada, China, France, Germany, Hungary, Italy, Netherlands, New Zealand, Poland, Russia, Spain, Turkey, United Kingdom and United States. This was supplemented by primary research with payors and organisations through interviews in native languages to identify potential risk-sharing agreements outside the public domain as well as general opinions. RESULTS: Thirty-two new risk-sharing agreements were found in the period of review (May 2011 - May 2012), which is roughly in-line with the rate found in previous years. The number of new drugs with risk-sharing agreements attached to them actually declined, and most new agreements are being negotiated for drugs which already have one in place. The majority of agreements tend to be finance-based, although new performance-based agreements continue to emerge, including in emerging markets. The majority continue to focus on the oncology arena. CONCLUSIONS: Although risk-sharing continues to be a routine part of market access in many countries, there appears to be a notable “levelling off” of the rapid expansion of this strategy in previous years. This is relatively unsurprising as it reaches a natural plateau, but still notable against the background of ongoing global austerity.